Provider Demographics
NPI:1568580256
Name:COOPER, SANDRA P (MA NCSP)
Entity Type:Individual
Prefix:MS
First Name:SANDRA
Middle Name:P
Last Name:COOPER
Suffix:
Gender:F
Credentials:MA NCSP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:940 N SEGOVIA DR
Mailing Address - Street 2:
Mailing Address - City:LITCHFIELD PARK
Mailing Address - State:AZ
Mailing Address - Zip Code:85340-4507
Mailing Address - Country:US
Mailing Address - Phone:623-535-5311
Mailing Address - Fax:
Practice Address - Street 1:940 N SEGOVIA DR
Practice Address - Street 2:
Practice Address - City:LITCHFIELD PARK
Practice Address - State:AZ
Practice Address - Zip Code:85340-4507
Practice Address - Country:US
Practice Address - Phone:623-535-5311
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-27
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ099129Medicaid